移植肾动脉狭窄介入治疗

Interventional treatment of transplanted renal artery stenosis

目的探讨移植肾动脉狭窄(TRAS)介入治疗的方法、疗效和安全性。方法经股动脉入路对12例TRAS患者行介入治疗,包括经皮血管腔内成形术(PTA)和支架置入术。患者从肾移植术后至出现肾动脉狭窄症状平均5.5个月(4～15个月),以手术前后血压、血肌酐、动脉狭窄程度作为判断疗效的指标。结果本组4例行单纯球囊(长20～40mm,直径5～7mm)扩张,5例于PTA后置入支架,3例直接置入支架。PTA术后2例(17%)复发狭窄,行支架置入术;支架术后3例再发狭窄,再次行PTA后无复发。12例患者先后共置入9枚球囊扩张式支架,1枚为自膨式支架。介入治疗前肾动脉狭窄率为65%～95%,术后狭窄率降为10%～25%;平均血压由术前175/105mmHg,降至术后140/80mmHg;平均血肌酐水平由术前475.5μmol/L降至术后118.5μmol/L;术后随访3～48个月(平均9个月),12例中最终治愈4例,改善5例,好转2例,无效1例。手术成功率100%,术中未发生血栓、出血、移植肾栓塞等严重并发症。结论TRAS的介入治疗安全有效,选择恰当入路,合理选择和组合运用PTA与支架置入术,可有效提高TRAS的远期疗效和手术成功率。

Objective To evaluate the treatment of transplanted renal artery stenosis （TRAS） by percutaneous transluminal angioplasty （PTA）and stentplacement. Methods The averange time from transplantation to the symptom occurrence of TRAS was 5.5 months （4 - 15 months）in 12 TRAS patients. All of them received the interventional therapy through femoral approach. Average BP, creatinine level and stenosis before and after the procedure were taken as the judgement standards. Results PTA was performed with balloon （ length 20 - 40 mm, diameter 5 - 7 mm）in 4 patients, stenting after PTA in 5, including 3 of direct stenting. Two cases （17%）occurred restenosis after PTA and restenting was undertaken. Three ases （25%）with restenosis after stentplacement were undergone PTA. One self-expandable stent and 9 balloondilatation stent were released in 10 cases. Stenosis significantly decreased from 65% - 95% preoperatively to 15%-25% postoperatively, together with average BP decreased from 175/105 mmHg to 140/80 mmHg and creatinine level decreased from 475.5 μmol/L to 118.5μmol/L. Among 12 cases included 4 healed, melioration （5）, improvement （2）, and inefficiency （1）during follow-up of 9 months （3 - 24 months）. No complication occurred. Conclusion The interventional therapy is effective and safe for TRAS with high rates of procedure success and efficacy. The proper selection of the adapted approach combined with PTA and stenting may effectively raise the long term efficacy for TRAS and success rate of the procedure.